Credentialing Lead

Overview

The Credentialing Lead is a senior healthcare operations leader responsible for provider credentialing, recredentialing, and payer enrollment across a growing medical organization. This role owns the end-to-end credentialing lifecycle for physicians and advanced practice providers (APPs) and ensures compliance with NCQA, CMS, state licensing boards, and payer requirements.

This position focuses on process improvement, compliance, audit readiness, and scalability, ensuring credentialing and enrollment operations support organizational growth without delays or regulatory risk.

This role is eligible for a performance-based bonus incentive.

• Own the full provider credentialing and recredentialing process for physicians, APPs, and clinical staff
• Manage payer enrollment with commercial, Medicare, and Medicaid plans
• Serve as the credentialing subject-matter expert for regulatory and accreditation requirements
• Maintain credentialing policies, procedures, and documentation standards

• Evaluate and improve credentialing workflows, cycle times, and handoffs
• Standardize credentialing and enrollment processes to support multi-state growth
• Develop SLAs, checklists, escalation paths, and quality controls
• Partner with HR, Medical Operations, Revenue Cycle, Compliance, Legal, and Contracting
• Ensure compliance with NCQA, CMS, state medical boards, and payer credentialing requirements
• Maintain audit-ready credentialing files and lead internal and external audits
• Identify credentialing and enrollment risks and implement mitigation plans
• Oversee clinician supervisory roster management
• Lead, train, and develop credentialing and enrollment staff
• Establish performance metrics and accountability
• Create documentation and training to reduce operational risk
• Scale credentialing team structure and workflows (Director level)

• Track and report on credentialing KPIs (time to credential, time to enroll, backlog, expirables)
• Provide clear status updates to executive and clinical leadership
• Set realistic credentialing and enrollment timelines with stakeholders

• 5+ years of experience in provider credentialing and payer enrollment
• Associate’s degree required;
  Bachelor’s degree in Healthcare Administration, Business, or related field preferred
• Proven experience managing provider credentialing operations in a healthcare or medical group setting
• Strong knowledge of NCQA, CMS, payer enrollment, and state licensing requirements
• Experience leading credentialing teams and improving operational performance
• Strong skills in process design, workflow optimization, and compliance management

• CPCS, CPMSM, or equivalent credentialing certification
• Experience in healthcare services, medical groups, MSOs, or value-based care organizations
• Experience supporting multi-state provider operations
• Experience implementing or optimizing credentialing software or enrollment platforms

Pay Range for Posted Region

$105,000 - $140,000 USD